Paul Collier in Foreign Policy (“How to Fix Haiti’s Fixers“) had a rather short piece arguing for a greater stewardship role of the Haitian government and increased transparency of NGOs’ service delivery outputs.
Although it’s true that the Haitian state cannot run mass service provision, the government could realistically allocate the funding for it. So, instead of donating to NGOs, donor money would all be streamed into a common pool. A new government agency would be charged with overseeing the common pool, setting clear criteria for NGO performance, monitoring the NGOs, and giving out money from that pool based on the set standards and community needs.
Lest we think it a simple matter of empowering state stewardship, the Lancet’s Jan 30th report (“Financing of health systems to achieve the health Millennium Development Goals in low-income countries“) from the High Level Taskforce on Innovative International Financing for Health Systems adds a strong dose of political reality on the challenges to reforming healthcare finance. Many of these points can be generalized to other public services.
This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid.
